Archive for the ‘EMS’ Category

This is a topic making its way around the social media sites and blogsphere. Not many people know about it though unless they read certain blogs. I can provide a list if anyone wants.

EMS 2.0 is basically a remapping of the current EMS system. It focuses primarily on ALS, but I think us supposedly lowly EMTs can learn from it as well. And I have posted on this before, so if you have read my blog Flawed, then you don’t need to read this if you wish.

The current system teaches us that all patients(PTs) NEED to go to the emergency department(ED). Why though? If someone has a stubbed toe, or has had abdominal pain for the past month, why should they go to the ED? An Urgent Care Clinic or their own doctor would be so much better for this!! I think EMS providers should be trained in recognizing certain illnesses and injuries that do not require an ED, and be able to transport them to an Urgent Care. I don’t know how many times I have had to take a PT in to the ED, just to have the staff get upset with ME over them being there. Yes, abdominal pain can be deadly in some circumstances, but if you have had it for the past 12 hours, and are walking straight with no tenderness, then you do not need to go to an ED. If it suddenly started, and it feels like your inside are being ripped apart, well, they be being ripped apart and you need immediate lifesaving help, otherwise known as an ED. Some EDs will take, and put a PT into the waiting room when they come in by ambulance, if they do not need immediate life saving treatment, which is awesome!

Still confused? OK, think of it this way, for some reason, something happened to you, you got in accident, fell off of a ladder, tripped and hit your head. 911 is called, we come, do our thing, and rush you to the hospital so you can at least be checked over. All fine things as who knows what is going on, somethings we can not do in the field like a CT Scan. But now, here you are at the ED, waiting, and waiting, and waiting. You complain about how long it takes to get your CT scan results read, so you can be released and go back to whatever it was you had been doing. Well, chances are that it is taking so long, because there are a few PTs there with the sniffles or an upset stomach, and think they are more important then you. If they had gone to an Urgent Care, chances are you may have been able to be seen faster. Now, you may be waiting because someone worse then you came in, and this should be the case if triage is working correctly.

Other people abuse ambulances them selves. Like the PT on Medicare/Medicade/self-pay, with a flu, requesting to go to a hospital on the other side of the county, when we have to drive past two other hospitals to get there. What can we do about that? For starters, take them to an Urgent Care! Maybe ask them, politely of course, if they want to go by ambulance and get the bill, or if they want to have a friend or family member drive them? Obviously we can not refuse to transport someone who is not a threat to us, because if that was an option, someone somewhere would abuse it and a PT would die.

How can this affect us EMT-Bs you ask? I think if ALS can choose whether a PT needs an ED, or an UC, then we should be able to gain some privileges as well. Now this applies mainly to NY, as everyone is different. I think we should be able to drop a King Airway, start an IV so the ED has access, and a few other things I can’t think of right now.

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As a rule of thumb, especially at work, I do not discuss politics or religion.

But as of late, politics and work have been butting heads, not as in the presidential campaign, or even local campaigns, no, politics with in the EMS community.

I will not mention any names of any companies, so I can keep my job!

As of late, there have been some exchanging of contracts in the local EMS providers where I am. And it is making waves, some of the competitors have even taken to bad mouthing others on public forums such as Facebook, I try to avoid this(see above line).

I understand politics in business, I have worked enough Fortune 500 companies to understand why and how it works.

But when it comes to EMS it is ridiculous. When one company will sit and watch, or drive by, a patient who just called 911, because it is not in their contract, infuriates me. Some workers will do this, granted they are the older generation, stuck in their ways I suppose. But does that make it right?

As the companies bicker over territories, and contracts, it is the patients who will get hurt in the end. Literally.

I understand that companies need to make money, but at whose expense? Usually mine actually, sadly. As it is the medics on the road who have deal with it face to face on a daily basis.

But as I said before, the patients will feel it as well, when company A is posted in company B territory, so they can fulfill their contract with business X, and a call goes out that A is closer to then B, thanks to B already out fulfilling their obligation with business Y, why should the patient have to wait for company B to respond, especially when A is maybe a block away? Sometimes even calling in company C for the call, just because company B doesn’t like company A. Who suffers in the end there?

I realize some of this may start with the people in the dispatch office when it comes to choosing what company goes where, but that is a problem as well, and needs to be worked on. If company B calls company C for the call, the dispatcher should advise them that company A is right there!

As for politics within the company, that has been going on ever since the first company started, and I chose not to comment on that in a public forum such as this for obvious reasons, lets just say, that, for now, I will not be participating in this. But when I do decide I am tired of actually working for my raises and promotions, instead of brown-nosing and such, the game will be a foot!

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There are many reasons I wanted to nights, some of them I can not say on here, but if you ask me personally I have no problem telling, certain people. The biggest reason is though, that I will be working the same hours as Anna does now.

I am looking forward to a different type of patient on nights. I expect more drunks, and less transfers. Transfers back to the residence or the nursing home don’t usually happen at night. I expect more drunks for obvious reasons. I think that emergency calls at night will be exactly that, an emergency call.

But, this all remains to be validated. As I have never worked a regular shift on nights in EMS before. Sure I worked nights at Lowes, McDonalds, and Corning. So the actual night/darkness thing I should be able to adapt readily to.

I have a different partner now, and with that comes different ways of doing certain things. But my new partner is experienced, just like the other one was, so I look forward to that. Different dispatchers and supervisors as well. I will leave that one alone, for obvious reasons!

Everyone keeps asking me at work if I am ready for this. Yeah. I am. I just need a new flashlight…

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Ten years ago, at quarter of nine in the morning, I was in Chemistry class. Doing what every sixteen year guy was doing in class, checking out the girl in class wearing a shear shirt (I remember who it was, but will respect privacy.) She had come in after the period break, saying someone just flew a jet into the World Trade Center. My first thought was “WTF is the world trade center?”, then I thought someone had flown a jet fighter into the building. I was wrong. We talked the teacher into letting us go down to the library instead of doing a lab, to watch the TVs down there. It was then that I saw the second jet fly into the other building. Everything changed. We watched as the towers fell.

I got home that day, after watching the news all day at school. No one was home but my Uncle Rick visiting from Mojave with his camper. First thing he said was “Fucking Ragheads are going to pay.” And we continued to watch the news.

Coincidently, it was also my first day, at my first job, working by myself in the kitchen of McDonalds. It was a slow night.

That day forever changed everything, how we fly, how we travel, how we view others everything. Friends and family started enlisting. I am proud of each and everyone of them. I lost one friend in Iraq, and another will never be the same after Afghanistan.

Now, now I put others before myself, doing what 343 firefighters and EMS professionals did on the infamous day. Ten years ago I never would haven even contemplated it.

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I routinely get asked how my day was. Lately I have responded with “Slow”. Then people say how that is a good thing because then nobody was sick, injured or hurt. When I tell them this is true but I wish it was busier, I get a lecture about how bad of a person I am wishing harm to someone.

Well…

What they do not realize, is that I would never wish harm to someone. It is just that I have a special skill set, I have been through lots of training, practice, practical’s, and skill tests to get these skills. Not everyone can do it. Some people who do this shouldn’t be doing it! And I am good at it. I want to use it. I feel like God gave me this skill set so I can help people. And if I am not helping people then it is going to waste.

It is kind of like a soldier, we train them to kill, and we train them to be good at it. But when they don’t get a chance to go to war, we go on about how much of a waste it is and downgrade our military. Then 9/11 comes along, 2 wars start, as well as keeping Korea and other hot spots manned, and running drug interdiction on the coast. All of a sudden we don’t have the troops needed and there is an out cry!

Now, yes I will admit that the adrenaline rush is there, it is not the sole reason I am in this profession. Helping people is kind of cliché, but is the truth. Lights and sirens? Yeah, can’t deny the pleasure I get in seeing two out of three cars pull out of my way (to the third car, it may be your family member I am rushing to take care of!)

I (and all my fellow EMS providers) have a very unique skill set that less than ten percent of the nation have! Do the math on that one!

I don’t want to see you get hurt, I just want to be there when you do!

Now I realize this is not my most well written post, and I am thinking of editing it, but it is something that has been nagging at me.

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Here’s something I found on the net. Sadly I don’t know the author, but if you do let me know so I can give credit where credit is due.

The medic stood and faced God.
Which must always come to pass.
He hoped his uniform was clean,
He’d gotten dressed kind of fast.

“Step forward now, Medic.
How shall I deal with you?
Have you always turned the other cheek?
To my church have you been true?”

The medic squared his shoulders and said,
“No Lord I guess I ain’t,
cause those of us who wade in blood,
can’t always be a saint.
I’ve had to work most Sundays,
and at times my talk was tough.
And at times I’ve been violent,
cause the streets are awful rough.

But I never took a penny
that wasn’t mine to keep…
although I worked a lot of overtime,
when the bills got far too steep.

And I never passed a cry for help,
though at times I shook with fear.
And sometimes, God forgive me,
I wept unmanly tears.

I know I don’t deserve a place
among the people here.
They never wanted me around,
except to calm their fears.

If you have a place for me, Lord,
It needn’t be so grand.
I never expected or had too much,
But if you don’t I understand.”

There was silence all around the throne,
where saints had often trod.
As there medic waited quietly
for the judgment of his God.

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The following does not represent my employer, nor does it represent the views of my employer. Rather it represents EMS in general. And my opinion.

I am new to EMS, only being in it for 2 years. So disregard this if you want.

The EMS system is flawed. There I said it. Many of us know it already though.

The biggest flaw I can think of is a simple one really. Some one with the sniffles calls 911, 911 dispatches an ambulance, the ambulance takes them to the ED. Now, that took an ambulance out of service, took up a bed and staff at the ED, and cost the patient hundreds if not a thousand dollars. I don’t have a problem with the ambulance doing the transport really. Most of the time another crew is standing by to take the next emergency call. My problem is transporting that patient to the ED. Why not just go to a local Urgent Care, or even the patients doctor if allowed? How much money would that save the patients insurance company? Effectively lowering insurance premiums? It would free up room and staff at the ED as well. How many times have you driven yourself to the Emergency Department, just to wait 2-10 hours to get seen? We all know that while you wait in the waiting room, whether it be with sniffles your self, or a more serious condition, there is someone sitting in a bed, sniffing or holding their stomach with indigestion. If we could transport to an Urgent Care, the more serious patients would get better care in the ED.

There are other flaws of course. Time on scene is one I hear about often from my patients, and family members. I have worked with some partners who get on scene, and as soon as the patient is in the rig, we are moving. There have been others who spend a rather large amount of time on scene. I have been on scene for 45 minutes before, while my partner works in the rig. Now, there are certain things that need to be done before transport begins, I understand this. I, myself, like to get a set of vitals before transport begins. Even if I got a set in the house or outside. I get in that rig, and take another set. Then we go. It doesn’t take long for a good set of vitals. ALS providers have things to do. IVs to start, 12-leads to do. I understand that as well. And it is fine to do them before we go, just as, I as a BLS provider, do certain thing’s before moving. But there comes a point where just sitting on scene gets ridiculous. Some things can be done during transport. Just think of how it looks to the family or bystanders. The ambulance comes screaming in, the medics jump out, grab their stuff and go in. Do their thing and wheel the patient out on the stretcher. Load them into the ambulance. Then sit there, and sit there, and sit there. If you do spend a while on scene, let the family know why at least. It is the professional thing to do.

Education I like to learn, I can sit down with a manual and just read it. But when I was attending class, there where something’s our instructor covered real fast, saying we don’t need to know it. But then, it was on the test. And besides, why would it be in the book, and on his syllabus, if it wasn’t important? Maybe this was just my instructor, I do not know. As I am new to EMS, this may be just me. But from what I read online, it is a big deal. The US in general could revamp education.

EMS2.0- This is a big topic for EMS bloggers. And I figure it is my turn to chime in. Some people look at ems2.0 as expanding our box and scope of practice. I figure, we a need new a box. A lot of the old timers in EMS don’t think anything needs to change. I disagree, we should be able to transport to Urgent Cares, time on scene should be modified, education should be revamped, BLS providers should have capabilities such as the King airway. But none of this will happen while we are looked at as “Ambulance Drivers”. To get EMS2.0 to truly take effect, we must get the publics support. Until the recognize this as a career, and demand better care. It will not happen. The more EMS providers we got onboard, the better. But with out the publics support, the old-timers will not recognize the need for change.

Thoughts? I would love some feedback.

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I work for a commercial EMS company. But like most of us I started out volunteer, and still do volunteer. There are differences. My vollie company has better equipment for instance, then my employer does. I have heard from some of my co-workers, that they think that vollies are less experienced and inadequately trained. Honestly? I don’t think so. I mean, yeah there are some vollies out there who never go to a CME class in their life. And there are some vollies who only jump the glory calls. But when I strictly was a vollie, I ran more calls a day then I do now in a paid job. My vollie department always has the most up to date training calendars, and CME classes available for us. My paid job? Not so much. Some people say that vollies have no heart, they are in it for the glory. For some, this may be true. But you know what? Vollies do it for FREE. So they must have heart, or else they wouldn’t be doing this. I have worked with a few paid personnel, who treat the PT like cattle, hook ‘em up to the LifePack, and then sit back and watch them, go through SAMPLE and OPQRST, then done. I have never seen a vollie do that.

And yeah, my volunteer ambulance corp. was a commercial business. They charge just as much for a BLS run as does my employer.

The other day I my partner and I had to do a SCT(Secure Critical Transport for you non-EMS folk). It was just a routine vent job, and as is the normal for my company, they put a third crew member with us. As we finished the job, and walked out of the ICU, the third member said that I have a “vollie mentality”. I asked him how so, and his response was because I wear a nylon holster with my rescue knife, mini-Maglite, trauma shears, and a pen. He further explained that this is a commercial company, and that only vollies wear holsters! He had no explanation when I asked him why. Now I started using that holster when I was strictly volunteer, yes. When I was going through my EMT classes, road training, precept time, and all of my practical. I used the holster. I have muscle memory you could say, when I come up on a trauma now. I don’t need to think about what pocket has what, no flaps or Velcro to undo to get my shears or Maglite. But this makes me a supposed lesser EMT? Right. And if it makes me look like a vollie? So what! I would think that hospital staff can see my starched uniform, picture ID with barcode, my professional attitude, and of course my care for the PT, and decide for them selves about me. I represent my company in a positive way. Anyways, I asked the instigator if vollies also strap a small backpack to their thigh like he does, to carry their gear in. Then walked away to finish my night.

Now don’t get me wrong. I love my job, and would never give it up. I get paid to do, what little boys growing up dream of doing. Everyday that I get up and go to work, I have to remind myself that this is real. Not a dream. I will always be a vollie though.

I love my company. They treat me with respect(except for above). I am more than just a number on a sheet of paper. It does have it’s issues though, but that is what the suggestion box is for!

Anyways, this was my first real post. Kind of a rant, but it points out an issue in some EMS departments I think. What do you think?